Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 741016 | CT |
NPI | 1003196221 |
---|---|
Provider Name | Dr. Luis Chavez De Paz |
First Address | West Hartford, CT 06119-1831 |
Second Address | Farmington, CT 06030-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2011 |
Last Update Date | 18/08/2011 |